arterial venous and lymphatic drainage of head and neck

2. AORTICARCHES
As the pharyngeal arches form during the 4th and 5th
weeks, they are supplied by arteries called aortic
arches from the aortic sac

3. The aortic arches arise from the aortic sac and
terminate in the dorsal aorta of the ipsilateral side
Though six pairs of aortic arches usually develop
All are not present at the same time
By the time the sixth pair of aortic arches has
formed, the first two pairs disappear
During the eighth week, the aortic arch pattern is
transformed to final fetal arterial arrangement

4. DerivativesAortic arches
1stpair of aortic arch Maxillary arteries and
external carotid.
2nd pair of aorticarch. Stapedial arteries.
3rd pair of aorticarch Common carotid and
internal carotid.
4th pair of aorticarch. Subclavian artery.
5th pair No vasculature.
6th pair of aorticarch Proximal part-pulmonary artery
and distal part- ductus
arteriosus.

5. Arteries Veins
Oxygen Concentration: Arteries carry oxygenated
blood (with the
exception of
the pulmonary arteryand
umbilical artery).
Veins carry deoxygenated
blood (with the
exception of pulmonary
veins and umbilicalvein).
Types: Pulmonary and systemic
arteries.
Superficial veins, deep
veins, pulmonary veins
and systemic veins
Direction of Blood Flow: From the heart to various
parts of the body.
From various parts ofthe
body to the heart.
Anatomy: Thick, elastic muscle
layer that can handle
high pressure of the
blood flowing through
the arteries.
Thin, elastic muscle layer
with semilunar valves
that prevent the blood
from flowing in the
opposite direction.
Overview: Arteries are red blood
vessels that carry blood
away from the heart.
resistance vessels
Veins are blue
blood vessels that carry
blood towards the heart.
capacitance vessels
Rigid walls: more rigid collapsible
Thickest layer: Tunica media Tunica adventitia

6. DIFFERENCES BETWEENARTERIES AND VEINS

7. CLASSIFICATION
Arch of aorta
Left subclavian artery
Brachiocephalic
artery
Right
subclavian
Right common
carotid
Left common
carotid
External C A Internal CA Ext CA Int CA

9. EXTERNALCAROTIDARTERY
COURSE &DISTRIBUTION:
The external carotid artery, arises opposite the upper border of the thyroid
cartilage, and taking a slightly curved course, ascends upwards and
forwards, and then inclines backwards, to the space b/w the neck of the
condyle of the lower jaw, and the external meatus, where it divides into
the temporal & internal maxillary arteries.
BRANCHES
 Superior
thyroid
 Lingual
 facial
POSTERIOR
 Occipital
 Posterior
Auricular
 Ascending
pharyngeal
TERMINAL
 Superficial
Temporal
 maxillary
ANTERIOR MEDIAL

10. EXTERNALCAROTIDARTERY& ITS BRANCHES

12. In the neck, both arteries runs
upward within the carotid
sheath.
Contents of carotid sheath-
- Common carotid artery
(medially)
- Internal jugularvein (laterally)
- Vagus nerve between the artery
&vein (posterially)
At the level of the upper border
of thyroid cartilage the artery
dividing into the external and
internal carotid arteries.

14. COURSE:
It arises from anterior aspect of
ECAforms a typical loop which
is crossed by XII nerve. Its 2nd
part lies deep to the hyoglossus.
The 3rd part runs along the ant.
Border of hyoglossus &4th part
runs forwards under the surface
of tongue.
DISTRIBUTION:
It is chief artery of muscular
tongue. It supplies various
muscles, papillae & taste
buds. also gives branches to
tonsils.
LINGUALARTERY

15. FACIALARTERY
It is chief arteryof face
It arises from the ECAjust above the tip of the greater
cornu of the hyoidbone
Two parts of facialartery-
1.Cervical part- runs upwards in the neck
2. Facial part- on the face
CERVICALPART-
It runs upwards on the pharynx deep to the posterior belly
of the digastric &to the ramus of mandible
It grooves the posterior border of submandibular gland

16. BRANCHES OFCERVICALPART
1.Ascending palatine-
- supplies the tonsil &root of the tongue
2. Tonsillar-
- supplies the tonsils
3. Submental-
- supplies thesubmental triangle &sublingual
salivary gland.
4.Glandular branches-
- supplies submandibular salivary gland &lymph
nodes

17. FACIALPART
Course-
It enters theface by winding around the base of the mandible, by
piercing the deep cervical fascia at the antero-inferior angle of the
masseter muscle.
First it runs upwards &forwards to a point half an inch lateral to
the angle of the mouth.
Then it ascensds by the side of the nose up to the medial angle of
the eye, where it terminates by supplying the lacrimal sac &by
anastomosing with the dorsal nasal branch of the ophthalmic
artery.
The facial artery is very tortuous.( Tortuosity of the artery prevents
its walls from being unduly stretched during movement of
mandible,lips &thecheeks)

18. Facial artery
Ophthalmic
Artery

19. BRANCHES OFFACIALPART
1. Inferior labial –
- supplies lower lip
2. Superior labial-
- supplies the upper lip &the anteroinferior part
of the nasal septum.
3. Lateral nasal-
- supplies to the ala &dorsum of the nose.

20. At the medial angle of the eye terminal branches
of the facial artery anastomosis with branches of
the ophthalmic artery (it is the site for
anastomosis between the branches of ECA & ICA)

21. LITTLE’S AREA
The anteroinferior part of septum contains anastomoses
between the superior labial branch of the facial artery and
sphenopalatine artery.The arteries anastomose to form the
plexus which is a common site for nose bleeds .It lies in the
anterior inferior part of the septum known as Little’s area.

22. 7. MAXILLARYARTERY
The maxillary artery, larger of the two terminal
branches of the external carotid artery.
3 parts
1. Mandibular- runs horizontally between neck of
mandible &sphenomandibular ligament.
2. Pterygoid- superficial or deep to the lower head of
the lateral pterygoid.
3. Pterygopalatine- between the two heads of the lateral
pterygoid through pterygomaxillaryfissure

24. First portion
The first or mandibular portion passes horizontally
forward, between the neck of the mandible and the
sphenomandibular ligament, where it lies parallel to and a
little below the auriculotemporal nerve; it crosses
the inferior alveolar nerve, and runs along the lower border
of the lateral pterygoidmuscle.
Branches include:
Deep auricular artery
Anterior tympanic artery
Middle meningeal artery
Inferior alveolar artery which gives off its mylohyoid
branch just prior to entering the mandibular foramen
Accessory meningeal artery

25. Second portion
The second or pterygoid portion runs obliquely
forward and upward under cover of the ramus of the
mandible and insertion of thetemporalis, on the
superficial (very frequently on the deep) surface of
the lateral pterygoid muscle; it then passes between the
two heads of origin of this muscle and enters the fossa.
Branches include:
Masseteric artery
Pterygoid branches
Deep temporal arteries (anterior and posterior)
Buccal artery

26. Third portion
The third or pterygopalatine portion lies in
the pterygopalatine fossa in relation with the pterygopalatine
ganglion. This is considered the terminal branch of the maxillary
artery.
Branches include:
Sphenopalatine artery (Nasopalatine artery is the terminal
branch of the Maxillary artery)
Descending palatine artery
Infraorbital artery
Posterior superior alveolar artery
Artery of pterygoid canal
Pharyngeal artery
Middle superior alveolar (a branch of the infraorbital artery)
Anterior superior alveolar arteries (a branch of the infraorbital
artery)

27. TRANSVERSE FACIAL ARTERY
Branch of superficial temporal artery.
After emerging from the parotid gland, it runs
forward over the masseter between the parotid
duct &zygomatic arch.
Accompanied by the upper buccal branch of facial
nerve.
It supplies the parotid gland &its duct ,the
masseter &overlyingskin.

28. APPLIEDANATOMY..
 The arterial supply of the pulp has its orgin from the posterior superior
alveolar arteries and infra orbital and the inferior alveolar branch of the
internal maxillary arteries.
 Any bacterial infection or to other stimuli by an inflammatory response to
pulp is known as pulpitis.
 Acute & Chronic pulpitis – RCT or Extraction
 Chronic hyperplastic pulpitis – RCT or Extraction

29. Hematoma
 The effusion of the blood into extra vascular spaces can result from
inadvertently a blood vessel.
 Caused by nicking to the artery or vein.
 Most occur with IANB and PSA nerve block.
 7 to 14 days the hematoma will be presented.
PREVENTION
 Use a short needle for PSA nerve block
 Minimize number of needle penetration.
MANAGEMENT
 Direct pressure should be applied to the site of bleeding.
 Do not apply heat to the area for at least 4 to 6 hours , apply cold moist
towel.

30. Complications of IANB
 HEMATOMA
 TRISMUS- muscle soreness or limited movement
 TRANSIENT FACIAL NERVE PALSY
 produced by deposition of LA into the body of the parotid ,blocking the 7th
cranial nerve.
 signs and symptoms include inability to close the lower eye lid and dropping
of upper lip on the effected side.

32. Veins
Systemic veins Pulmonary Veins
-Right Pulmonary vein
-Left Pulmonary vein
Head &Neck Abdomen &Thorax Upper limb Lower limb
Veins
Systemic veins Pulmonary Veins
-Right Pulmonary vein
-Left Pulmonary vein
Head &Neck Abdomen &Thorax Upper limb Lower limb

33. External group
a) Internal jugular
b) External jugular
c) Anterior jugular
d) Oblique jugular
e) Posterior external jugular
Internal group
a) Venous sinuses
b) Emissary veins
c) Diploic veins

34. Applied anatomy:
A. Facial vein is common source of bleeding following
surgery involving posterior vestibule lateral to
mandible
B. Infection from face can spread in a retrograde direction
and cause thrombosis of the cavernous sinus. This is
specially occur in presence of infection in upper lip and
lower part of nose. Called dangerous area of the face.
Dangerous area of the face.

35. Lingual
vein
 The lingual veins begin on the
dorsum, sides, and under
surface of the tongue, and,
passing backward along the
course of the lingual artery, end
in the internal jugular vein.
 Drains tongue and
sublingual region
 Three branches
a) Dorsal lingual veins
b) Deep lingual veins
c) Sublingual vein

36. Maxillary vein
• It begins in the infratemporal fossa
•It collects blood from the pterygoid
Plexus
•Through the pterygoid plexus It
receives the middle meningeal,
posterior superior alveolar, inferior
alveolar and other veins from the
nose and palate (areas served by
The maxillary artery)
•After that it merges with the
superficial temporal vein to form
the retromandibular vein

37. Anastomosis of facial
vein

38. Venous drainage of teeth and supporting structures
• The vein related to mandibular teeth may be
collected into one or more inferior alveolar veins
which may drain anteriorly into facial vein or
posteriorly to pterygoid plexus of veins.in the
maxilla also veins drain either into facial vein or
pterygoid plexus of vein.

39. Lymphatic
drainage

40. Definition:
The lymphatic system is the part of the immune
system comprising a network of conduits called
lymphatic vessels that carry a clear fluid called lymph
(from Latin lympha "water") in a unidirectional
pathway.
The widely and extensively dispersed vessel system
collects tissue fluids from all regions of the body to
eventually convey them towards the heart.

41. EMBRY0LOGYOFLYMPHATICSYSTEM
Lymph sacs -appear between 2nd to6th
week of IUL.
7th week -jugular channel spread to connect
with subclavin lymphsacs.
9th week - thoracic duct is continuous
channel draining into IJ -subclavinvein
junction.
12th week- all process are complete.
5th month -valves begins to start.

42. VALVES
Except initial lymphatic sinus or capillaries every lymph
vessels has valves.
Valves may be
 Bicuspid
 Tricuspid
 Quadricuspid

43. Functions:
•It is responsible for the removal of interstitial fluid
from tissues i.e. act as "drains“
to collect the excess fluid and return it to the venous
blood just before it reaches the heart preventing
massive edema (which can cause tissue destruction:
“pressure necrosis”).
•Returns back to circulation, the protiens that may
have escaped into interstitial spaces.

44. Lymphatic tissue is a specilized connective tissue -
reticular connective, that contains large quantities of
lymphocytes(filter fluids prior to adding it to
circulation).
It transports immune cells to and from the lymph
nodes in to the bones
The lymph transports antigen-presenting cells (APCs),
such as dendritic cells, to the lymph nodes where an
immuneresponse is stimulated.
works with the circulatory system to deliver nutrients,
oxygen, and hormones from the blood to the cells that
make up the tissues of the body.

45. Lymphatic drainage of teeth and
supporting structures
 The lymph vessels from the teeth usually run directly into the
submandibular nodes on the same side.
 Lymph from lower incisor teeth may drain into submental
nodes.
 Sometimes molars may drain directly into jugulo-digastric
group of nodes.

46. Asound knowledge of the regional lymph nodes of the
head and neck is very important for dentists because
it is a reliable guide towards the origin of
problem, and because of the possible involvement of
the lymphatic system in the
spread of infection or the spread
of malignant tumour cells
(metastasis).
Rolein dental practice

47. Rolein dental practice
Clinical significance:
1. Diagnostic value
2. Aid in prediction of treatment outcome
(modification of treatment plan/course)
3. Prediction of disease history and therefore
prognosis.
4. Lymph vessels can also transmit other substances
such as injected material or neoplastic cells.

48. Classification of nodes
in head and neck region

49. The lymph nodes in the head and neck region can be
grouped into:
• Superficial nodes
• Deep nodes.
Classification of nodes
in head and neck region

50. The superficial cervical lymph nodes lie above the
investing layer of the deep fascia.
They consist of a few small nodes that lie superficial
to the external jugular and anterior jugular veins.
Thesuperficial lymph nodes

51. Thesuperficial lymph nodes
1. Submental
2. Submandibular
3. Buccal
4. Parotid (pre-auricular)
5. Mastoid (retro auricular/post-auricular)
6. Occipital
7. Superficial cervical
8. Anterior cervical.

52. SUPERFICIAL LYMPH NODES

53. TheDeeplymph nodes:
1. Upper deepcervical
2. Lower deepcervical
3. Waldyer’s ring
4. Nodes of midline

54. The waldyer’s ring is formed by: lingual,
palatine, tubal, and pharyngealtonsils.
Midline nodes are termed in correspondence to
the anatomical area where they exist:
A. Infrahyoid
B. Prelaryngeal
C. Pretracheal
D. Paratracheal

55.  Composition of lymph- clear colour less fluid
formed by 96% water and 4% solids
 Solids- may be inorganic , organic and cellular
content.
 Inorganic –
- Na
-Ca
- K
- Cl
- HCo3

56. Head and neck drains:
• The scalp drains into the occipital, mastoid and parotid nodes.
• Lower eye lid and anterior cheek drains into buccal LNs.
• The cheeks drain into the parotid, buccal and
submandibular nodes.
• The upper lips and sides of the lower lips drain into the
submandibular nodes.
While the middle third of the lower lip drains into the
submental nodes
• The skin of the neck drains into the cervical nodes.

57. Thedrainage of the oralstructures
• The gingivae drain into the submandibular,
submental and upper deep cervical lymph nodes.
• The palate drains via lymph vessels that pass
through the pharyngeal wall to the upper deep
cervical nodes.
• Teeth drain into the submandibular and deep
cervical lymph nodes.
• Anterior part of mouth floor drain into submental
and upper deep cervical while posterior part into
submandibular and upper deep cervical.

59. PALPABLE LYMPHNODES ANDPROBABLE
ASSOCIATEDCONDITIONS
infection
Tender, Mobile, enlarged  Acuteinfection
Non-tender, Mobile, Enlarged  Chronic
Matted, Non tender  Tuberculosis
Fixed, Enlarged  Carcinoma
Rubbery, Enlarged  Lymphomas

60. EXAMINATION OF LYMPH NODES
1. Lymph nodes should be examined from patients behind.
2. Examination is done by asking patient to flex his neck
slightly to reduce tension of muscles
3. To palpate, use the pads of all four fingertips.
4. Examine both sides of head simultaneously while applying
steady gentle pressure.

61. SUBMANDIBULAR NODES
Palpated from behind the patient, with patient’s
chin tipped slightly towards the chest.

62. SUBMENTAL NODES
Roll the fingers below the chin(in the midline) with patient’s head
tilted forwards

63. ANTERIOR/POSTERIOR CERVICAL LYMPH
NODES
They lie anterior & posterior to sternomastoid muscle.
Tip of fingers are used to palpate anterior nodes, medial to
sternomastoid muscle and posterior nodes behind the muscle
while patient’s head tipped slightly forwards.

64. PAROTID NODES/PREAURICULAR NODES
73
Roll the finger in front of ear , against the maxilla

65. POSTAURICULAR/ MASTOID NODES
74
Roll the finger behind the ear

66. 8
CAUSES OF ENLARGEMENT OF LYMPH NODES
* Inflammatory
(a) Acute Lymphadenitis
(b) Chronic Lymphadenitis
(c) Lymphogranuloma inguinale
* Neoplastic
(a) Benign – non-existent
(b) Malignant
1. Primary
(i) Lymphosarcoma
(ii) Hodgkin’s disease.
2. Secondary
(i) Sarcoma
(ii) Malignant melanoma
(iii) Carcinoma

67. • Autoimmune Disorders
AIDS
(i) Juvenile rheumatoid arthritis
(ii)Other collagen diseases such as Polyarteritis
nodosa and scleroderma.
76

68. CAUSES OF INDIVIDUAL LYMPH NODE
ENLARGEMENT
Sub mandibular Nodes
• Conjunctivitis
• Sinusitis
• Tonsillitis
• Pharyngitis
Sub mental Nodes
•Periodontitis
•EBV infections
•CMV infections
•Toxoplasmosis 77

69. Deep cervical nodes
•Pharyngitis
•Rubella
•Lymphoma
•Tuberculosis
•Head and neck cancer
Occipital nodes
•Local infection
•Secondary Syphilis
•Neoplasm
78

70. Postauricular nodes
•Otitis Externa
•Secondary Syphilis
•Rubella
Preauricular nodes
•Local infection
•Herpes Zoster
•Rubella
• Syphilis
•Tuberculosis
79